Get Empire Blue Cross Blue Shield Edi Registration Form 2016-2025
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How to fill out the Empire Blue Cross Blue Shield EDI Registration Form online
Completing the Empire Blue Cross Blue Shield EDI Registration Form online can streamline your enrollment process for electronic data interchange. This guide provides step-by-step instructions to help you fill out each section of the form accurately and efficiently.
Follow the steps to successfully complete the EDI registration form.
- Click the ‘Get Form’ button to access the form and open it in your editor.
- Indicate your request by selecting the appropriate option under 'Requester/Action'. Options include 'New', 'Submitter Set Up', and specify current submitter details if applicable.
- Fill in your current submitter ID if you are adding to an existing setup or updating information. Indicate the type of submitter you are, such as 'Physician', 'Hospital', 'Clearinghouse', or 'Billing Service'.
- Enter your organization’s name, address, suite number, city, state, and zip code in the designated fields.
- Provide the contact person’s name, phone number, email address (this field is required), and fax number.
- Complete the fields for Group Billing NPI and Tax ID to identify your billing information.
- Identify the individuals responsible for the development or maintenance of your EDI software. Choose between 'In House Development' or 'Software/System Vendor' and provide their contact information.
- Select the data transmission method you will use from the available options: SFTP, HTTPS Portal Upload, or HTTPS/SOAP Real-Time.
- Choose the HIPAA transactions you will be utilizing. Common options include 837P Claim, 837I Claim, and others. Check all that apply.
- After submitting, note that new submitter IDs will require completion of the supplemental 835 registration e-form for enrolling in additional services.
- Once you have filled all necessary fields, review the form for completeness and clarity before saving your changes. You can download, print, or share the completed form as required.
Complete the Empire Blue Cross Blue Shield EDI Registration Form online today to facilitate your electronic data interchange needs.
The fax number for Empire Blue Cross can vary based on the type of documents you're submitting. As of the latest information, it's best to check directly on the Empire Blue Cross Blue Shield website or contact their customer service for the most accurate fax number. Prepare your documents correctly and use the Empire Blue Cross Blue Shield EDI Registration Form to facilitate the submission process.
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